Provider Demographics
NPI:1568518314
Name:IRWIN B. MALAMENT DPM A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:IRWIN B. MALAMENT DPM A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:IRWIN
Authorized Official - Middle Name:BERNARD
Authorized Official - Last Name:MALAMENT
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:317-299-2644
Mailing Address - Street 1:3410 N HIGH SCHOOL RD STE C
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46224-1100
Mailing Address - Country:US
Mailing Address - Phone:317-299-2644
Mailing Address - Fax:317-328-8914
Practice Address - Street 1:3410 N HIGH SCHOOL RD STE C
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46224-1100
Practice Address - Country:US
Practice Address - Phone:317-299-2644
Practice Address - Fax:317-328-8914
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-26
Last Update Date:2011-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN441-B213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN1002358801AMedicaid
IN1002358801AMedicaid
IN0434370001Medicare NSC